All the people health care hires to handle health insurance

Marketplace on NPR has begun an occasional series called “The Cure.” The lead-in to the first segment said:

“Up first, the inner workings of a typical medical practice. Did you ever wonder, for instance, what all those people on the other side of the counter are actually doing? And why there are so many of them? We sent Marketplace’s Tamara Keith to find out.”

Keith spent the day at a doctor’s practice, seeing firsthand why there were more administrative staff than health care professionals in this particular practice. They’re dealing with health insurance – and different flavors of insurance from different health insurance companies. It’s the American way. It’s the marketplace at work that anti-health care reform forces want to preserve.

Listen to it. It’s good radio journalism.

But you should also read the comments section following the text story on the Marketplace website. One guy wrote:

“I worked for Ingenix, a subsidiary of UnitedHealth group, for three years as a software developer. I worked on a crack team of Java developers who used cutting edge technology to build two huge software systems: ContractManager and iCES.

ContractManager cost $150,000 a seat. It sat in the offices of large physician practices and analyzed the doctor’s rejected claims and figure out ways to bleed more money from insurance companies.

iCES sat in the office of insurance companies and analyzed claims using high technology with the intent of finding ways of paying doctors less.

Our shorthand internal way of describing what we did: “Selling guns to the Hatfields and the McCoys.”

Having worked for several insurance companies, I must point out that the single payer, public option is the way to go. Right now, providers and payers are having an arms race and you and I are paying for both sides.”

A physician friend of mine in Los Angeles told me her office deals with 94 different insurance plans. 94 DIFFERENT INSURANCE PLANS! And none of the people who push that paper do anything directly to benefit your health. Amazing.

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Mike D

August 11, 2009 at 8:29 pm

I have been HIV+ for almost 25 years and have been fortunate to have health coverage, but I appreciate how precarious my position is and how easy it would be to lose this benefit during this 25 year period, I have dealt with doctors as our of network and in-network. I seen the reimbursement for the same type of visit and test vary by more than 500%. I have seen where there are multiple people in a doctors office dealing with and seen myself spending hours on the phone trying to sort through payments. I am enough of a free market supporter that I don’t like the idea of a single payer insurance plan, but something has to go. There is just too much waste in trying to support the insurance companies and their battles of payments.